Thrombectomy methods
Methods and apparatuses for removing material (e.g., clot) from within a body, including inverting thrombectomy apparatuses. These methods and apparatuses may include methods and apparatuses for reusing portion of the devices, method and apparatuses for loading and reloading the inverting thrombectomy apparatuses, and methods and apparatuses for improving and enhancing the ability of the inverting thrombectomy apparatuses to remove clot. In particular, described herein are expandable scraper devices that may be used in conjunction with the inverting thrombectomy apparatuses descried herein, or on their own.
1. A method of removing clot, the method comprising:
positioning an expandable scraper device within a lumen of a vessel in an unexpanded configuration so that an expandable braided basket of the expandable scraper device is positioned distal to or within the clot;
expanding the expandable braided basket to an expanded configuration against a wall of the vessel lumen where the expandable braided basket is configured to apply a maximum scraping force against the wall of the vessel lumen of 1.5 pounds of force or less, wherein the expandable braided basket is loosely braided so that it deforms along the long axis to limit the maximum scraping force to 1.5 pounds or less; and
pulling the expandable braided basket proximally while adjusting a pull force by operating a control on a handle of the expandable scraper device to expand or contract the expandable braided basket to maintain the pull force between about 0.2 and 1.5 pounds of force to scrape clot material from the wall of the vessel lumen without damaging the wall of the vessel lumen.
2. The method of claim 1 , wherein expanding the expandable braided basket comprises expanding the expandable braided basket against a bias force configured to return the expandable braided basket to the unexpanded configuration in an unconstrained state.
3. The method of claim 1 , wherein expanding the expandable braided basket comprises expanding the expandable braided basket from a length of between 3 and 10 cm in the unexpanded configuration.
4. The method of claim 1 , wherein expanding the expandable braided basket comprises expanding a braid of between 20 and 60 nickel titanium wires each having a diameter of between 0.15 mm and 0.35 mm into the expanded configuration.
5. The method of claim 1 , wherein expanding comprises expanding the expandable braided basket so that an inner elongate member which extends between a distal end of the expandable braided basket and a proximal end of the expandable braided basket is positioned within the expandable braided basket offset from a midline of the expandable braided basket.
6. The method of claim 1 , wherein adjusting the pull force by operating the control on the handle of the expandable scraper device comprises operating a finger slider to manually adjust expansion of the expandable braided basket to maintain the pull force between about 0.2 and 1.5 pounds of force.
7. The method of claim 1 , wherein adjusting the pull force by operating the control on the handle of the expandable scraper device comprises operating both a release button and a finger slider to manually adjust expansion of the expandable braided basket to maintain the pull force between about 0.2 and 1.5 pounds of force.
8. The method of claim 1 , wherein adjusting the pull force by operating the control on the handle of the expandable scraper device comprises releasing a ratcheting lock on the handle to expand or contract the expandable braided basket.
9. The method of claim 1 , further comprising providing feedback of the pull force applied.
10. The method of claim 1 , further comprising applying suction to remove clot material from the vessel lumen.
11. The method of claim 1 , wherein pulling the expandable braided basket proximally comprises maintaining the pull force at an approximately constant level.
12. The method of claim 1 , wherein positioning the expandable scraper device within the lumen of the vessel comprises inserting the expandable scraper device through a catheter and pulling the expandable braided basket with clot to a distal tip of the catheter and aspirating clot through the catheter.
13. The method of claim 1 , further comprising repeatedly positioning the expandable scraper device within the lumen of the vessel to scrape a same location of the vessel by advancing the expandable scraper over a guidewire in the collapsed configuration, expanding the expandable scraper, and pulling the expandable braided basket proximally while adjusting the pull force.
14. The method of claim 1 , wherein pulling the expandable braided basket proximally comprises adjusting the pull force by operating a control on a handle of the expandable scraper device to expand or contract the expandable braided basket to maintain the pull force between about 0.2 and 1.5 pounds of force to scrape clot material from the wall of the vessel lumen without damaging the wall of the vessel lumen as a diameter of vessel walls change along a length of the vessel walls.
15. A method of removing clot, the method comprising:
positioning an expandable scraper device within a lumen of a vessel in an unexpanded configuration so that an expandable braided basket of the expandable scraper device is positioned distal to or within the clot;
expanding the expandable braided basket against a wall of the vessel lumen where the expandable braided basket is configured to apply a maximum scraping force against the wall of the vessel lumen of 1.5 pounds of force or less, further wherein the expandable braided basket is biased to return to the unexpanded configuration in an unconstrained state, and wherein the expandable braided basket has a length of between 3 and 10 cm in the unexpanded configuration, wherein the expandable braided basket is loosely braided so that it deforms along the long axis to limit the maximum scraping force to 1.5 pounds or less and is formed of between 20 and 60 nickel titanium wires each having a diameter of between 0.15 mm and 0.35 mm; and
pulling the expandable braided basket proximally while adjusting a pull force by operating a control on a handle of the expandable scraper device to expand or contract the expandable braided basket to maintain the pull force between about 0.2 and 1.5 pounds of force to scrape clot material from the wall of the vessel lumen without damaging the wall of the vessel lumen.
16. The method of claim 15 , wherein expanding comprises expanding the expandable braided basket so that an inner elongate member which extends between a distal end of the expandable braided basket and a proximal end of the expandable braided basket is positioned within the expandable braided basket offset from a midline of the expandable braided basket.
17. The method of claim 15 , wherein adjusting the pull force by operating the control on the handle of the expandable scraper device comprises operating a finger slider to manually adjust expansion of the expandable braided basket to maintain the pull force between about 0.2 and 1.5 pounds of force.
18. The method of claim 15 , wherein adjusting the pull force by operating the control on the handle of the expandable scraper device comprises operating both a release button and a finger slider to manually adjust expansion of the expandable braided basket to maintain the pull force between about 0.2 and 1.5 pounds of force.
19. The method of claim 15 , wherein adjusting the pull force by operating the control on the handle of the expandable scraper device comprises releasing a ratcheting lock on the handle to expand or contract the expandable braided basket.
20. The method of claim 15 , further comprising providing feedback of the pull force applied.
21. The method of claim 15 , further comprising applying suction to remove clot material from the vessel lumen.
22. The method of claim 15 , wherein pulling the expandable braided basket proximally comprises maintaining the pull force at an approximately constant level.
23. The method of claim 15 , wherein positioning the expandable scraper device within the lumen of the vessel comprises inserting the expandable scraper device through a catheter and pulling the expandable braided basket with clot to a distal tip of the catheter and aspirating clot through the catheter.
24. The method of claim 15 , further comprising repeatedly positioning the expandable scraper device within the lumen of the vessel to scrape a same location of the vessel by advancing the expandable scraper over a guidewire in the collapsed configuration, expanding the expandable scraper, and pulling the expandable braided basket proximally while adjusting the pull force.
25. The method of claim 15 , wherein pulling the expandable braided basket proximally comprises adjusting the pull force by operating a control on a handle of the expandable scraper device to expand or contract the expandable braided basket to maintain the pull force between about 0.2 and 1.5 pounds of force to scrape clot material from the wall of the vessel lumen without damaging the wall of the vessel lumen as a diameter of vessel walls change along a length of the vessel walls.
26. A method of removing clot, the method comprising:
positioning an expandable scraper device within a lumen of a vessel in an unexpanded configuration so that an expandable braided basket of the expandable scraper device is positioned distal to or within the clot;
expanding the expandable braided basket against a wall of the vessel lumen where the expandable braided basket is configured to apply a maximum scraping force against the wall of the vessel lumen of 1.5 pounds of force or less, wherein the expandable braided basket is loosely braided so that it deforms along the long axis to limit the maximum scraping force to 1.5 pounds or less, further wherein the expandable braided basket expanded against a bias force configured to return the expandable braided basket to the unexpanded configuration in an unconstrained state; and
pulling the expandable braided basket proximally while adjusting a pull force by operating a control on a handle of the expandable scraper device to expand or contract the expandable braided basket to maintain the pull force between about 0.2 and 1.5 pounds of force to scrape clot material from the wall of the vessel lumen without damaging the wall of the vessel lumen,
wherein adjusting the pull force by operating the control on the handle of the expandable scraper device comprises releasing a ratcheting lock on the handle and sliding a slider to expand or contract the expandable braided basket.
27. The method of claim 1 , wherein pulling the expandable braided basket proximally comprises at least partially inverting the basket.
28. The method of claim 15 , wherein pulling the expandable braided basket proximally comprises at least partially inverting the basket.
29. The method of claim 26 , wherein pulling the expandable braided basket proximally comprises at least partially inverting the basket.